Health Secretary Andrew Lansley has unveiled the first batch of GP-led consortia from across England that will pilot the government’s radical new plans for commissioning health services.
Known as ‘pathfinders’, 52 groups of GP practices have been approved by ministers to take on responsibility for healthcare commissioning, working together to manage budgets and buy services for patients hand-in-hand with other NHS colleagues and local authorities.
The pathfinders include 1,860 GP practices that collectively provide care to 12.8 million people across England, which means that a quarter of the population will already start to benefit from the new system centred on clinical leadership before the planned national rollout, the Department of Health said.
The number of practices forming the pilot consortia varies considerably, the Red House Group in Hertfordshire being comprised of just three, while, at the other end of the scale, 90 practices make up the County Durham and Darlington group. “The range of pathfinder consortia’s sizes and shapes (organisationally) shows that the era of ‘one-size-fits-all, dictated-from-Whitehall’ is over for good,” said Michael Dixon, chair of NHS Alliance, and he applauded Lansley’s “courage and resolve in standing by his statements that the NHS should not be run from the centre, but led locally”.
And it seems patients are already benefiting from local commissioning and healthcare services tailored to their needs. For example, in Bexley the local NHS identified the need to improve cardiology services and, as a result of successful local commissioning, patients are now being taken from their own doorstep directly to Harley Street clinic for CT scans, saving costs and preventing the need for unnecessary invasive treatments, the DH said.
Lansley has expressed delight by the response and enthusiasm for trailblazing the new plans. “They have demonstrated an enthusiasm and excitement for change and shown that there are many GPs ready and willing to take on commissioning responsibilities, so they can make the decisions that better meet the needs of their local communities and improve outcomes for their patients,” he said.
And, he notes, this is just the start, as more GP consortia are waiting in the wings to join the pathfinder programme, which is designed to enable as many consortia as possible to road test the new arrangements before GP consortia take on statutory responsibilities from April 2013.
But the British Medical Association says it is not surprised the number of GPs that have already signed up to the programme. “Many GPs have recognised that they will need to be at the heart of this programme for it to work,” explained Richard Vautrey, deputy chair of the Association’s GPs Committee. “They know that difficult savings decisions need to be made in the coming year and they want to be involved in making those together with the primary care trust”.
Warning note
In a note of caution, the GPC also stressed that PCTs – which will get the chop along with Strategic Health Authorities in a bid to slash bureaucracy – will ultimately retain responsibility for budgets until at least April 2013, and so “transitional GP-led consortia should be careful not to get locked into arrangements, particularly as the health bill that will enact white paper proposals has not been put to parliament yet”.
And despite Lansley’s insistence that there is much support for his plans, there is also widespread concern over the scale and speed of the changes. Katherine Murphy, chief executive of the Patients Association, said GP commissioning has the potential of “reducing the powerlessness felt by people when service decisions are made, seemingly not on clinical needs, but on organisational requirements alone”.
But she stressed that the pace of reforms were of concern. “We are now in a position where almost a quarter of the population are living in an area covered by Pathfinders. This is not a ‘testing of the new commissioning arrangements’; this is implementation before the results of the consultation have even been published or a Bill laid before Parliament,” she noted.
